In a missed abortion, the woman usually is not aware of the loss, specifically when there is no vaginal bleeding or abdominal pain. A missed abortion can happen in the first or second trimester, though it usually happens in the first trimester. A missed abortion is usually diagnosed when the blood hCG fails to increase as expected, or when on ultrasound there is either no embryo (blighted ovum), or when there is an embryo or fetus but no heartbeat.
Most miscarriages will eventually have symptoms such as bleeding or passage of tissue. Symptoms of a miscarriage such as light or heavy bleeding and passage of fluid usually begin with a missed abortion. The embryo or fetus has died several weeks before there are symptoms and the bleeding begins. The difference between a miscarriage that begins with bleeding and a missed abortion is that the missed abortion was diagnosed by ultrasound or a blood test and before there is bleeding or other symptoms.
A misssed abortion in the first trimester is diagnosed by the arrest of embryonic or fetal development and/or the absence of a fetal heart beat.
Treatment of a missed abortion
Treatment of a missed abortion should include giving women the option between:
1. expectant management
2. surgical management
3. medical management
Surgical management includes doing a dilatation & curettage (D&C), while medical management usually includes giving misorprostol (600-800 mcg) vaginally.